Tuesday, October 10, 2006

When did the movement to empower pregnant women turn into a guilt-laden cult?

... To me, the widespread use of epidurals indicates not that insensitive doctors are forcing them on women against their better interests, but that most women, given a choice, opt to make childbirth as comfortable as possible. Call me crazy, but I lean this way myself.

And much of the time I do feel crazy -- or at least heretical -- amidst what I have come to call "birth culture." ... It's a culture of midwives and doulas (who assist midwives or act independently as labor and postpartum support), as well as of prenatal yoga and birth-education classes. It's also a culture of birth plans (giving instructions to hospital staff on everything from medication to the level of lighting preferred), birthing tubs (to soak in during labor), and birth art (photographs of moms-to-be au naturel and plaster-of-Paris "bellymasks," capturing for all time the swollen stomach)...

With its roots in feminism, this culture has encouraged women to take control of their pregnancy and birth rather than submit to societal expectations of quiet endurance or to patronizing obstetricians who prefer their patients unconscious. Women have let it be known that they want to see their babies arrive into the world and to challenge seemingly unnecessary heavy medical interventions, like the routine performance of cesarean sections and the induction of labor, so that doctors can deliver during office hours. Because the culture refuses to view birth as a messy and slightly embarrassing event, it has brought dads into the delivery room to experience the moment themselves and to give much-needed support to their partners.

These are the aspects of the culture that I am drawn to.

What makes me uncomfortable is its cultish worship of the experience. Not the experience of loving and nurturing a baby, mind you, but of the nine months leading up to it. The same nine months that, for many women, begin with uncontrollable retching, take in a weight gain of 30 pounds or more (which profoundly warps their self-image, not to mention their ability to breathe), and that end with the most intense pain they've ever experienced.

If I seem overly negative, it's only because the image portrayed in birth culture is often so unrealistically positive. Consider, for example, this warning, found in that bible of birth-education classes, Pregnancy Childbirth and the Newborn (written by several teachers at the Childbirth Education Association of Seattle, including well-known guru Penny Simkin), about how a woman might react to a labor that is -- gasp -- unusually short: "You may experience disappointment because your labor passed so quickly you were not able to savor it, use all the breathing and relaxation techniques, or share it with your partner as you had planned." So labor is to be savored. Believe me, if I could get away with delivering a baby in five minutes, I'd jump at the chance. But that's a perspective seldom heard among "birth junkies," as one doula-in-training described herself to me.

It's not just birth in general that is so idealized, however. Somewhere along the line, the movement to empower pregnant women to make informed childbirth choices turned into a pressure-laden, guilt-inducing campaign for the right kind of birth -- that is, the "natural," unmedicated variety. The reasons seem to have less to do with mom's or baby's health and comfort than with some abstract notion of the hardy earth mother who takes birth in her stride as yet one more demonstration of her power. "Isn't it interesting," my husband said to me one day, "that the movement that's supposedly feminist is the one that insists on women feeling pain?" It is indeed.

On the claim that "pregnancy is not a disease":

One troubling mantra to have emerged from birth culture is "Pregnancy is not an illness." Among its implications are the propositions that we don't need well-meaning exhortations to sit down, thank you, and we certainly are not going to stop working. Yet I felt sicker and more miserable than I can ever remember. At my worst point, I simply could not work...

But because little I had read or heard validated my physical and psychological decline, I was embarrassed about it. I didn't want friends to call or visit me. Luckily, one persisted and looked up for me an Internet chat group that was chock-a-block full of messages from pregnant women who felt like dying. I learned from this and from my doctor that my experience was far from unique. In fact, some women have it so bad they have to be hospitalized.

On pain relief in labor:

... Yet the bias against drugs is so strong that they are barely mentioned during the description of labor offered in class and in our textbook Pregnancy Childbirth and the Newborn. Even though the vast majority of women use drugs, as my yoga classmate discovered, we are taught what labor feels like under the unspoken assumption that we're going natural. At no point are we told: "This is what labor feels like if you choose drugs, this is what labor feels like if you don't."

When we do learn about drugs several weeks later, it's in a way that's not very informative. A long list of drugs is thrown at us, without much guidance as to which to concentrate on. Buried is the fact that the epidural is the most effective and widely used means of alleviating pain. Along with a description of the advantages of all these drugs, we are also given a far longer description of potential side effects. Missing is a perspective on how frequently they occur. It's like reading the packaging on aspirin: Yes, it might cause ringing in the ears or hearing loss, but is the risk great enough to stop a reasonable person from taking it? ...

I am not a reckless person. If I heard a clear case against using drugs on the grounds that they endangered me or my baby, I'd face my fear and prepare to do without. What I hear, however, is that fear should be faced for the sake of it, that labor is some kind of psychological test, and that only wimps take the easy way out with drugs. The almost misogynistic message is no less plain for being subtle, as in our textbook's explanation of why women opt for medication: "It is when you think that your labor is worse than it is supposed to be that you begin to worry and seek relief with pain medications or anesthesia." God forbid women should seek relief from labor's all-too-normal torment.

0 Old Comments:

About Me

Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, How Your Baby Is Born, an illustrated guide to pregnancy, labor and delivery was published by Ziff-Davis Press in 1994. She can be reached at DrAmy5 at aol dot com.

No one may use the name Homebirth Debate in any manner, including in metatags or other devices utilized in any manner designed to divert traffic to a site other than our site without our prior written consent. Any such use will be prosecuted to the fullest extent permitted by law.